After years of talking with teens and their parents about substance use, here's the single most important thing I've learned: Connection matters more than control.

I hear it from parents all the time: "I'm scared my teen might be using drugs, but I don't know how to bring it up." These fears are valid.

Although most teens don’t use drugs or alcohol, some do: Adolescence is a time of exploration and risk-taking, and today's substances — from high-potency cannabis to counterfeit pills laced with fentanyl — are far more dangerous than in previous decades. Despite these fears, a December 2025 University of Michigan study found that drug use among U.S. teens remained low for the fifth year in a row after a sharp decline in 2020/2021.

And here's the good news: You have more influence than you think. Here, I'll share what I often tell parents in my clinic. This is practical advice drawn from research and my experience having real-life conversations to help you keep your teen safe, supported and informed.

When parents worry about substance use, the first instinct is often to tighten the reins: take away a teen's phone, search their room and threaten punishment. But research and experience show that what teens need most is connection, not control. Instead of jumping right to discipline, start a conversation. It's best to have these talks early and often, long before you're worried that your teen has come home after using drugs or alcohol. Conversations are more productive when they happen outside the heat of the moment, when everyone is calm and open.

Ask open-ended questions like, "What have you heard about vaping at school?" or "How do your friends feel about drinking?" When teens feel judged, they shut down. But when they feel heard, they often open up.

Trust is protective. Scare tactics, on the other hand, can backfire. They can damage communication and make teens less likely to come to you when they're in trouble. Research shows that when teens feel mistrusted or shamed, they're more likely to hide their behavior rather than change it. Building a foundation of openness and honesty gives you more influence in the long run.

Substance use looks different now than it did a generation ago. While alcohol is still the most commonly used substance among teens, high-potency cannabis use — especially in the form of vapes or edibles — is increasingly common. Nicotine vaping has also surged in recent years.

One of the biggest concerns today is the risk of counterfeit pills. Some teens experiment with pills that they believe to be Xanax, Percocet or Adderall—when in fact, they may contain fentanyl or other drugs. Even one pill can be fatal because these contaminants are often highly potent and can cause an overdose quickly.

Staying informed about what teens are actually using can help you have more meaningful conversations. When teens sense that you're up to date on what's happening in their world, they're more likely to take you seriously. It also shows them that you care enough to understand, not just to judge.

Sometimes, it's hard to tell whether a teen is experimenting or truly struggling. If you notice changes in mood, sleep, appetite, school performance or friendships, bring it up with your pediatrician.

Pediatricians are trained to screen for substance use and mental health concerns. In addition, teens often feel more comfortable talking to a doctor than to a parent. In some cases, your pediatrician may recommend a counselor, therapist or substance-use specialist. For teens who are dealing with true addiction, it's more common than not that they're also facing another mental health condition like anxiety, depression, ADHD or trauma. Treating both mental health and substance use problems together is essential — and help is available.

One of the most important goals in adolescence is delaying substance use for as long as possible. The earlier a teen starts using substances, the more likely they are to develop a substance use disorder later in life. For example, teens who start using cannabis before age 18 are twice as likely to go on to have a problem with substance use disorder than if they start later.

That said, the goal shouldn't be perfection—it's protection. Even if your teen has experimented, you can still make a difference. Be curious, and ask questions like, "How might you respond if someone at a party offers you a drink?" Play to a teen's strengths. For example, if your teen has an independent streak, tap into that. You might say, "You've never been someone who follows the crowd — how do you think that could help you make decisions if friends start using drugs or alcohol? "

There is a lot of positive messaging about alcohol and drugs on TV and in social media; sometimes you might be the only voice sharing that you think it's important not to use substances. Make a clear recommendation that you don't want your teen to use. You might say, for example, "I care so much about your health and safety. I don't want you using alcohol or other drugs, especially while your brain is still developing." Teens may roll their eyes—but research shows they still hear you, and it matters.

One of the most important family rules to establish is about never driving under the influence—or riding with someone who is. Let your teen know they can always call or text you (or another trusted adult) for a ride, no questions asked.

If you're not available, ride share services like Uber or Lyft can be a good backup option — but only if your teen knows how to use them safely.

It's also worth talking about naloxone (Narcan), a medication that reverses opioid overdoses. Naloxone is safe, easy to use, and available in most pharmacies without a prescription. Every household — especially those with teens — should have it on hand.

The most powerful prevention tool you have is your ongoing relationship with your teen. Don't worry about giving one perfect lecture. What matters most is having lots of small conversations over time. Talk during a car ride, while doing dishes, over Sunday family breakfast or at bedtime. Be curious. Be calm. Let them know you're always there to talk — about anything. Even if your teen has already experimented, it's never too late to help guide them.

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Scott Hadland, MD, MPH, MS, FAAP, is a practicing pediatrician and addiction specialist. He serves as Chief of Adolescent Medicine at Mass General Brigham for Children and an Associate Professor of Pediatrics at Harvard Medical School. Dr. Hadland leads NIH-funded research on adolescent substance use and mental health.

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